Topic Contents

Heart Valve Replacement Surgery: Minimally Invasive Methods

Topic Overview

In conventional open-heart surgery, the surgeon makes an incision in the chest and then spreads the ribs to expose the
heart. This type of incision is called a sternotomy.

In minimally invasive heart surgery, the surgeon makes a smaller incision in the chest. The
aortic valve is located near the front of the chest. So surgeons have discovered
that aortic valve replacement can be done successfully through this
smaller opening.

Surgeons may do this minimally invasive surgery in different
ways. These variations include different ways to:

Bypass the heart with a heart-lung
machine.

Protect the heart during surgery.

Make the
incision in the chest to access the heart.

Despite these variations, in all other ways the technique for
replacing the aortic valve is the same in minimally invasive surgery as in
conventional valve surgery.

What are the potential benefits of minimally invasive valve replacement surgery?

Less invasive surgery can have benefits over conventional valve
replacement surgery. These benefits include:

Less blood loss during
surgery.

Reduced need for blood transfusions.

Reduced
chance of irregular heartbeat during surgery.

Possibility of
removing the breathing tube sooner after surgery.

Less pain during
recovery from surgery.

Shorter hospital stay.

A smaller
scar.

Lower risk of infection.

Easier treatment in
cases of infection.

Quicker recovery and return to previous level
of activity.

Lower overall risk of complications, including
death.

What are the controversies over these benefits?

Researchers are still studying the results of minimally invasive
surgery to figure out whether all these benefits can be attributed to this
technique. Some studies have found that people who had minimally invasive
surgery enjoyed many of these benefits. Other studies have found that there has
not been a significant difference between minimally invasive surgery and
conventional valve replacement surgery, at least in some areas of potential
benefit.

Minimally invasive surgery can be safe and effective for the
purposes of replacing the aortic valve. One drawback is that because
this surgery is more technically complex, it often takes longer to complete. So
far, this increase in time required for surgery does not appear to have had an
impact on how well the surgery works. The one benefit that
minimally invasive surgery is guaranteed to provide is a smaller scar, given
that the incision is smaller. But it still remains to be seen whether the
benefits consistently extend beyond this cosmetic benefit.

Should I consider minimally invasive valve replacement surgery?

Surgeons are still working to perfect minimally invasive surgery.
Greater experience with this technique will likely decrease the time required
for surgery and increase the chance that people who have this surgery will
enjoy the benefits.

Your decision to have minimally invasive surgery, if that option is
available to you, should be based on your doctors' explanations of the benefits
and any potential drawbacks of the surgery, which should be based on their
experience and current medical literature. You should ask your surgeon about
how minimally invasive surgery has benefited other people who had the surgery
and what any recent studies have shown.

Also, ask your surgeon how many minimally invasive surgeries he or she has done.

Whether you have the option of choosing to have minimally invasive
surgery instead of conventional valve surgery will depend on several things,
including whether your:

Doctor recommends it.

Heart surgeon
does minimally invasive surgery and recommends it for
you.

One important limitation of minimally invasive surgery is that if
you also need to have coronary artery bypass surgery during your valve
replacement surgery, minimally invasive surgery may not be an option because it
does not provide sufficient access to your coronary arteries.

Related Information

References

Other Works Consulted

Rosengart TK, et al. (2008). Percutaneous and minimally invasive valve procedures. A scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation, 117(13): 1750–1767.

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